Senger-Carpenter Thea, Zhang Anao, Ordway Monica, Stoddard Sarah A, Voepel-Lewis Terri
Department of Health Behavior and Biological Sciences (T Senger-Carpenter and T Voepel-Lewis), University of Michigan School of Nursing, Ann Arbor, Mich.
University of Michigan School of Social Work (A Zhang), Ann Arbor, Mich; Adolescents and Young Adults Oncology Program at Michigan Medicine (A Zhang), University of Michigan, Ann Arbor, Mich.
Acad Pediatr. 2025 Jan-Feb;25(1):102568. doi: 10.1016/j.acap.2024.08.013. Epub 2024 Aug 27.
To determine whether anxiety and depression symptoms are mechanisms through which adverse childhood experiences (ACEs) contribute toward persistent/recurrent pain (PRP) across early adolescence.
This study described the direct and indirect (ie, mediated) effects of ACEs on PRP across early adolescence, using 4 years of Adolescent Brain Cognitive Development Study data. Annual pain frequency, anxiety, and depression symptoms were measured using the Child Behavior Checklist, and youth with pain for ≥3 of the 4-year study period were classified with PRP. Early (up to age 9-10 years; reported at baseline) and recent (at age 10-11 years; reported at year 1) ACE exposures were derived from parent and youth completed surveys. Structural equation modeling estimated the direct and indirect associations among early and recent ACEs, pain outcomes, and anxiety/depression symptoms reported in the year(s) in between.
Among 7951 youth, 2540 (31.9%) were classified with PRP. Higher levels of early ACE exposure were associated with an increased probability of having PRP (adj. β 0.65 [95% confidence interval {CI} 0.07, 1.22). Early ACEs also had indirect effects on PRP via higher interim anxiety (adj. β 5.36 [95% CI 3.45, 7.26]) and depression symptoms (adj. β 4.57 [95% CI 3.01, 6.13]). Early and recent ACE exposures predicted higher pain frequency scores in subsequent years, with mixed results regarding the role of anxiety and depression in the relationships between ACEs and pain frequency scores.
Anxiety and depression symptoms are potentially important interventional targets to lower the risk for PRP among youth exposed to ACEs.
确定焦虑和抑郁症状是否是童年不良经历（ACEs）在青春期早期导致持续性/复发性疼痛（PRP）的机制。
本研究利用4年的青少年大脑认知发展研究数据，描述了ACEs对青春期早期PRP的直接和间接（即中介）影响。使用儿童行为检查表测量年度疼痛频率、焦虑和抑郁症状，在4年研究期内疼痛≥3年的青少年被归类为PRP。早期（9至10岁之前；在基线时报告）和近期（10至11岁；在第1年报告）的ACE暴露来自家长和青少年完成的调查问卷。结构方程模型估计了早期和近期ACEs、疼痛结果以及其间各年份报告的焦虑/抑郁症状之间的直接和间接关联。
在7951名青少年中，2540名（31.9%）被归类为PRP。早期ACE暴露水平较高与患PRP的可能性增加相关（调整后β 0.65 [95%置信区间{CI} 0.07, 1.22]）。早期ACEs还通过较高的中期焦虑（调整后β 5.36 [95% CI 3.45, 7.26]）和抑郁症状（调整后β 4.57 [95% CI 3.01, 6.13]）对PRP产生间接影响。早期和近期的ACE暴露预测了随后几年更高的疼痛频率得分，关于焦虑和抑郁在ACEs与疼痛频率得分关系中的作用，结果不一。
焦虑和抑郁症状可能是降低暴露于ACEs的青少年患PRP风险的重要干预靶点。
